Prior Authorization Codes Updated for Commercial Members

December 18, 2023

What’s Changing: Blue Cross and Blue Shield of Montana is changing prior authorization requirements that may apply to some commercial members, to reflect new, replaced or removed codes.  These changes are based on updates from utilization management prior authorization assessment, including Current Procedural Terminology (CPT®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System (HCPCS) code changes from the Centers for Medicaid & Medicare Services. A summary of changes is included below.

Important Reminder: Always check eligibility and benefits first through the Availity® Essentials Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.

Changes include:

  • April 1, 2024 – Addition of Genetic Testing codes reviewed by Carelon Medical Benefits Management
  • April 1, 2024 – Addition of Infusion Site of Care codes to be reviewed by BCBSMT
  • April 1, 2024 – Addition of Medical Oncology drug codes to be reviewed by Carelon
  • April 1, 2024 – Removal of Medical Oncology drug codes previously reviewed by Carelon
  • Jan. 1, 2024 – Removal of a Specialty Pharmacy code previously reviewed by BCBSMT

More Information: For a revised list of codes go to the Prior Authorization and Recommended Clinical Review (Predetermination) section of our provider website. 

CPT copyright 2023 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.

Carelon Medical Benefits Management (Carelon) is an independent company that has contracted with BCBSMT to provide utilization management services for members with coverage through BCBSMT.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT.